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This is the final installment of the Q & A on barefoot running vs shoes. I’m sure next week will bring further discussion and probably a post or two on unanswered questions, but the interview done earlier this year with Run2Day is at an end. A short post today, and some practical applications, which are my suggestion for how barefoot running would be introduced into running to avoid the very likely overload on the calves and Achilles tendons early on.

What’s struck me most in this discussion, apart from that it’s so passionately debated (which we knew before the series began) is how large the range of approaches to the subject is. There are biomechanical angles, historical angles (the Roman army features as protagonists), anthropological angles, economic perspectives, evolutionary arguments, and so on. Many of which support running barefoot, many which do not. So thank you for educating me on those topics.

I think it’s safe to say that there is no obvious answer, as is the case for many questions. But it’s an intriguing debate, and it will be interesting to track how the ‘movement’ progresses in the next few years. What would be really cool, for example, would be to track the sale of Vibrams across the US to see how the consumer responds to all this information, because the surest test of whether it works will be resale of Vibrams – if people buy the third and fourth pair, then they’ve converted.

Anyway, here goes with the final few questions.

14. Do you have any news on innovations or research related to this subject which you’d like to share with us?

Not so much an innovation, but a concept that I think is also important for understanding why running barefoot might reduce injury risk. We have heard so often in this series, and elsewhere, that people who switch to barefoot running find that they can run injury free. We look at biomechanics as the explanation for this, when in fact the more simple answer is right in front of us.

That is, if you run barefoot, your training volume is limited by what your feet allow you to do. For example, if you take two runners, equally untrained and with equal risk of injury, and you give one of them a pair of shoes and the other runs barefoot, I guarantee you that the barefoot runner will do LESS training in the first month than the runner in shoes. Why? Because his feet will hurt, his calves will be much stiffer, his ankles will hurt, and his distances, which he can select for himself, will be cut down substantially.

The runner in shoes, on the other hand, has only a stiffness barrier to overcome. He is stiff for a day or two after this first run, but that soon disappears, and then he can increase the distance without restraint. Pretty soon, he’s doing 4 or 5 runs a week, total of 50 km a week, which may be too much, too soon. His barefoot companion, however, has been forced to increase much more gradually. He also gravitates towards softer surfaces, offering more variety in landing type.

The guy likely to get injured in the above scenario is the shod runner. And so when you read testimonies from people who have thrown away their shoes and run barefoot and they proclaim that being barefoot has cured all their injury concerns, you need to ask very seriously – was it being barefoot that sorted out their injury, or did being barefoot alter their training, which sorted out their injuries?

This is why the only “perfect” study that will prove (to me, anyway), the benefit of running barefoot, is a study that forms three groups. All runners must have identical histories, demographics, injury risks (there goes the study right away, of course. But within reason, this is doable). Group 1 gets shoes and chooses their own training volumes. Group 2 runs barefoot and chooses their own training based on feedback and their perceptions around pain and recovery. Group 3 is in shoes, but they run according to a very conservative programme, which increases their distance by about the same amount as the barefoot group would select by themselves. This controls for self-selected increases in workrate.

In the short term, the rates will not be different. Yes, there is a long-term consideration and that is why this study would have to continue for at least a year, probably more. I honestly don’t know what would be found if this is done. But to address the common perception that being barefoot is a ‘cure’ for injuries, you have to question whether it’s a consequence of the impact on training volume.

I cannot stress enough that the reason for injury is training, which brings us full circle and back to the study of van Gent. Shoes, running technique and so forth are factors, yes, but the only factor that is KNOWN to cause injury is training too long, too hard, too soon (or combinations of the three). And so when you approach this debate on shoes vs barefoot and injuries, it’s vital to bear this in mind – training is key and any runner who trains at the right level for their history and circumstances (this is where strength, flexibility, stability come into it), will not get injured.

15. With all research in mind, what would you opt for: choosing either barefoot or padded running (for maximum adaptation to one style) or choosing a mixed training (to keep the body alert to changes and train different groups of muscles)?

Mixed training, without a doubt. Again, hypothetically speaking, if you took a group of runners and you attempted to put them all on a barefoot programme, I would put forward that a third of them will pick up a limiting injury within 3 weeks. A calf or Achilles injury, most probably. They’ve probably overdone the limit and trained too much, of course, but their failure is a training one, and it’s for this reason that Daniel Lieberman, and others are trying so hard to advocate a prudent approach to training.

The irony is that even podiatrists are not against the idea of barefoot running. At least, not the ones I know of. But they’re just adopting a cautious approach, in the absence of evidence to the contrary, and they recognize that one approach does not fit all.

However, if the return to barefoot is managed very carefully, with short distances, and infrequent runs, then it would be possible to see positive outcomes. And I’d even say this is desirable. Barefoot running does affect running mechanics, and I believe it affects them positively. It’s also a lot of fun – I’ve got two pairs of Vibrams and I run in them once a week and it’s really very enjoyable, a different feeling and a stimulating way to train. Having started out with slow, and very short running, I’ve been able to build the distance to the point where I can finish normal sessions. But it’s been 6 months and my soleus muscle still hurts the day or two afterwards, and I can’t imagine being more conservative with how I’ve increased the volume of training. Therefore, I view barefoot running as a training tool, with mechanical and muscular benefits, but I can’t, at this stage, see the feasibility of going all the way to half marathons in Vibrams. Lightweight shoes, yes, but not all the way. And that’s fine, just as it is for a few other runners who I’ve advised on the same thing.

In terms of applying this to training, conservative is key. My advice would be that if you’re keen on barefoot running, you limit it to once a week at first, and you limit the length of each run to 50% of your normal distance, and you break it up into intervals of about 5% with walking between.

For example, if your average run is 60 minutes, then my advice is that you head out for 30 minutes, but that you run for 2 minutes, walk for 1 minute, 10 times. At least for the first few week or two, and then gradually increase the running from there, if you feel your feet, ankle and calves are up to it.

16. Conclusion: Barefoot running/Natural Running: Religion or Ratio?

Ratio, given those two options. The neutral view is likely the best and most accurate one in this particular debate. The shoe industry made the error of positioning itself as the “solve-all” for runners when it said that it would reduce injury risk. I wasn’t around at the time, but I’d be willing to be that in the 1990s, if you didn’t have the latest gadget or gizmo on your shoe, along with rather large cushioning, your running was doomed to failure…We’ve looked at evidence to the contrary in the last few posts. So I think it’s important not make the same error now and dismiss out of hand what many runners have succeeded with.

It’s very easy to point to high injury risks of runners (60 to 70%) and say that shoes don’t help these runners. But there’s no control group, and one might equally argue that it’s incredible that the injury rate is not higher than 70%. As I said yesterday, we are a desk-bound society, which is inactive as children and which takes to a 60 minute a day run on unforgiving surfaces as though we expect our bodies to handle it. We carry with us years of “neglect” and weakness is stabilizing muscle groups, and we pay little attention to training strength. We also recklessly increase training volume, and yet are surprised when we pick up injuries (I myself am just as guilty of this!). And then we find the culprit – the shoe!

Balance is key. There are people who may not be able to run barefoot, however slowly they increase their volumes. There are people who find that they can. Perhaps some day everyone will be running barefoot or in lightweight shoes, who knows? But right now, with the sum of the available evidence, I’m happy to say that barefoot running is a great way to train, it’s different and stimulating and offers many mechanical benefits, but like most things, generalizing will wrongly influence too many people for it to be dogma.

Looking ahead

As I said, next week will probably see some more discussion on the topic. I’m in Hong Kong for the next Sevens tournament, maybe it’s time to do a little bit of rugby science posting to pass the last week of the tour. And the marathon season is slowly approaching, which promises to provide a lot of discussion and interesting analysis, so that’s something to look forward to!

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We published The Runner's Body in May 2009. With an average 4.4/5 stars on Amazon.com, it has been receiving positive reviews from runners and non-runners alike. Available for the Kindle and also in paperback.